Specific Pharmacologic Therapies

Polymyositis, dermatomyositis, and idiopathic, inflammatory, and granulomatous myopathies are often somewhat responsive to immunomodulation treatments. Prednisone is the gold standard, although its efficacy has never been confirmed in a well-designed prospective study; typically, prednisone equivalents of 1-1.5 mg/kg/day are started. In order to diminish the severity of the corticosteroid side effects, alternate-day dosing and appropriate dose tapers must be considered as soon as symptoms are adequately controlled. Sequential CK measurements may be useful in following disease activity, and a rise in CK may herald a clinical relapse while on treatment. Previous tuberculosis exposure should be excluded before initiation of steroid treatment. Vitamin D and calcium are regularly supplemented in patients on prednisone, particularly in women. Bone densitometry is indicated for patients at risk of osteopenia. Serum glucose and potassium levels need to be monitored at regular intervals and treated or supplemented when needed.

Other immunomodulation therapies including intravenous immunoglobulin (IVIG), plasma exchange, azathioprine, methotrexate, mycophenolate mofetil, and monoclonal antibody against CD20-positive lymphocytes, known as rituximab, are available.

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  • Category: Nervous diseases